Interpreting congenital heart disease outcomes: what do available metrics really tell us?

As interest in measuring the cost and quality of health care has increased, congenital cardiac surgery has increasingly been scrutinized. To accurately assess the performance of one's own congenital cardiac program and to interpret data presented by outside entities, an understanding of the available metrics and their limitations is essential. Our ability to assess quality in congenital cardiac surgery is constrained by the data and evidence available. Evaluating the surgical patient in the context of all patients with congenital cardiac disease will help determine the effectiveness of a program's broader approach. Tracking of long-term outcomes, including morbidity, mortality, neurological status, and functional status will help focus attention on the results and the timeline that matter most to patients and their families. Defining structural and process measures that affect outcome not only may improve the results of congenital cardiac surgery but may lead to improvement in other patient populations that share hospital resources.